全景超声生物显微镜和眼前节光学相干断层扫描在检测斜视患者内外直肌止端位置中的应用

doi:10.3760/cma.j.cn115909-20191021-00283

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摘要目的：探讨应用全景超声生物显微镜（UBM）和眼前节光学相干断层扫描仪（AS-OCT）测量斜视患者角膜缘到水平眼外肌止端距离的可行性及准确性。方法：系列病例研究。术前应用全景UBM和 AS-OCT测量斜视患者角膜缘到水平眼外肌止端距离，然后术中用卡尺测量角膜缘到水平眼外肌止端距离。采用Friedman检验、Mann-Whitney U检验、Spearman相关性分析、Kendall一致性检验和Bland-Altman进行数据分析。结果：共纳入2018年3─9月在沈阳爱尔眼视光医院就诊的斜视患者73例，分析133条水平肌肉（72条外直肌、61条内直肌）。角膜缘到水平眼外肌止端的距离，在外直肌和内直肌中，UBM测量值分别为6.60（5.34～8.28）mm、5.41（4.16～7.48）mm，AS-OCT测量值分别为6.59（5.10～8.80）mm、5.17（3.44～7.41）mm，术中卡尺测量值分别为7.0（5.0～8.5）mm、 5.0（3.5～7.0）mm。比较3种测量方法在外直肌和内直肌中的差异，除内直肌中UBM与术中卡尺测量差异有统计学意义外（P=0.017），余差异无统计学意义。Spearman相关分析显示外直肌中UBM、 AS-OCT测量值分别与卡尺测量值存在强相关关系（r=0.656、0.608，均P<0.001），UBM测量值与 AS-OCT测量值存在中等相关关系（r=0.530，P<0.001）；内直肌中UBM测量值、AS-OCT测量值与卡尺测量值存在中等相关关系（r=0.597、0.458，均P<0.001），UBM测量值与AS-OCT测量值存在弱相关关系（r=0.379，P=0.003）。Kendall的非一致性检验和Bland-Altman提示3种测量方法间有良好的一致性。结论：全景UBM和AS-OCT可以准确测量初次斜视手术患者角膜缘到水平眼外肌止端的距离。

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关键词 ： , 全景超声生物显微镜, 眼前节光学相干断层扫描, 斜视, 眼外肌

Abstract： Objective: To evaluate the feasibility and accuracy of panoramic ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) in measuring the distance of the limbus to the horizontal extraocular muscle (EOM) insertion in strabismus patients. Methods: This was a case series study. We compared the panoramic UBM and AS-OCT measurements of muscle insertions to the gold standard intraoperative measurement and to each other. The Friedman test, Mann-Whitney U test, Spearman's rank correlation, Kendall's coordination coefficient and Bland-Altman plots were used to analyze data. Results: A total of 133 unoperated horizontal muscles of 73 patients at Shenyang Aier Eye Hospital were measured from March 2018 to September 2018, and 72 lateral rectus muscles and 61 medial rectus muscles were analyzed. The mean limbus-insertion distances of the lateral rectus and medial rectus measured with UBM were 6.60(5.34-8.28)mm and 5.41(4.16-7.48)mm, with AS-OCT were 6.59(5.10- 8.80)mm and 5.17(3.44-7.41)mm, and with a caliper were 7.0(5.0-8.5)mm and 5.0(3.5-7.0)mm. When comparing the 3 methods for detecting unoperated muscles, there was no significant difference between them regarding limbus-insertion distance measurements except that both the UBM gave higher preoperative limbus-insertion distances for the medial rectus than the caliper (P=0.017). Spearman correlation analysis indicated that there were strong correlations between UBM and the caliper and AS-OCT and the caliper (r=0.656, P<0.001; r=0.608, P<0.001) and there was a medium correlation between UBM and AS-OCT measurements of the lateral rectus (r=0.530, P<0.001). There were medium correlations between UBM and the caliper, and AS-OCT and the caliper (r=0.597, P<0.001; r=0.458, P<0.001), and there was a weak correlation between UBM and AS-OCT measurements of the medial rectus (r=0.379, P=0.003). Kendall's nonparametric consistency test and the Bland-Altman diagram suggested good agreements between the three methods. Conclusions: Both the panoramic UBM and AS-OCT are sensitive tools in identifying horizontal rectus muscle insertions in primary strabismus surgeries.

Key words： panoramic ultrasound biomicroscopy anterior segment optical coherence tomography strabismus rectus muscle

收稿日期: 2019-10-21

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通讯作者: 杨积文（ORCID：0000-0002-5206-1994），Email：yangjiwen1975@vip.163.com

引用本文:

段瑞1 杨积文1，2 刘佳2. 全景超声生物显微镜和眼前节光学相干断层扫描在检测斜视患者内外直肌止端位置中的应用[J]. 中华眼视光学与视觉科学杂志, 2020, 22(10): 756-763. Rui Duan1,Jiwen Yang1, 2, Jia Liu2. A Study of Panoramic Ultrasound Biomicroscopy and Anterior Segment Optical Coherence Tomography Measurements of the Horizontal Rectus Muscle Insertion in Strabismus. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(10): 756-763. DOI: 10.3760/cma.j.cn115909-20191021-00283

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20191021-00283 或 https://www.cjoovs.com/CN/Y2020/V22/I10/756

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